STATE OF CANCER CARE IN AMERICA

Transcription

1 2017 STATE OF CANCER CARE IN AMERICA AT A GLANCE

2 ASCO 2017 State of Cancer Care in America: 20.3 million cancer survivors predicted by 2026, a 31% increase from 15.1 million survivors in million cancer deaths averted since Progress & Opportunity Tremendous activity is occurring across diverse stakeholders to improve the lives of patients with cancer. 52% of oncology practices share electronic health record (EHR) data with patients. 43% of physicians are already receiving some portion of their reimbursement under value-based systems. 8 AT A GLANCE The U.S. cancer care delivery system is quickly transforming to better meet the needs of people with cancer. Advances in risk assessment, prevention, disease detection, drug development, and care delivery are leading to reduced rates of incidence and mortality for many common cancers, with more patients surviving their disease. Despite these gains, more people will be diagnosed with common aging-associated cancers as the U.S. population continues to grow and age. Ensuring patients access to affordable, high-quality care remains a critical challenge. This At A Glance provides an overview of the American Society of Clinical Oncology s (ASCO) fourth annual State of Cancer Care in America report, which describes the progress in cancer care delivery and the challenges confronting the cancer care community. The full-text version is published in the Journal of Oncology Practice at ascopubs.org/doi/ /jop A digital version of the "At A Glance" is available at asco.org/state-of-cancer-care. NEW APPROACHES: PRECISION MEDICINE AND IMMUNOTHERAPY Greater investment in research is moving cancer care toward the full potential of precision medicine and treatment advances. In 2016, the Food and Drug Administration approved: 16 new and expanded use cancer therapies 3 Meaningful improvements in survival for patients with some historically challenging diseases 34% of patients with metastatic melanoma treated with new immunotherapy in early clinical trial, alive after 5 years. 6 First liquid biopsy diagnostic test 4 VS. First next-generation sequencing diagnostic test 5 18% of U.S. patients diagnosed with metastatic melanoma between 2006 and 2012, alive after 5 years. 7 By creating momentum among public and private enterprises, the Beau Biden Cancer Moonshot Initiative launched dozens of cutting-edge initiatives and cross-disciplinary partnerships. Congressional passage of the 21st Century Cures Act includes $352 million in supplemental National Institutes of Health funding to support the initiative. Powerful learning systems REAL-WORLD EVIDENCE AND DATA SHARING Improved patient care Rapid Learning Systems Driving Cancer Innovation CancerLinQ is the learning health system developed by ASCO to use the power of data analytics to learn from each patient to improve cancer care delivery and patient outcomes. 70+ vanguard practices representing more than 2,000 physicians. Enabling learning from every patient Measuring quality in real-time Providing clinical decision support PRACTICE TRANSFORMATION Innovative payment models promote and incentivize high-quality cancer care, while reducing costs and paving the way toward value-based reimbursement. MACRA The Centers for Medicare & Medicaid Services (CMS) triggered significant practice transformation through implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Advanced Alternative Payment Models (APMs) Physicians may choose from two options to derive their Medicare payments starting in 2019 Clinical Pathways 58% Merit-based Incentive Program (MIPS) of surveyed oncology practices used clinical pathways in Clinical pathways are increasingly used to improve quality and reduce cost by promoting adherence to evidence-based treatment plans. 1 2

3 Challenges Despite rapid progress, major hurdles still impede patient access to high-quality cancer care. THE PATIENT PERSPECTIVE Rising cost of care Even among patients with health insurance, a cancer diagnosis can be financially catastrophic. Treatment is becoming more expensive, burdening patients and the cancer care delivery system as a whole. About one in three working-age cancer survivors incurred debt as a result of cancer treatment costs % Rate of uninsured Americans as of early 2016 vs 16.0% in Patients with fewer financial reserves reported more pain and poorer quality of life. 10 Health insurance coverage 55% of those who incurred debt owed $10,000 or more and 3% declared bankruptcy. 9 A wide body of evidence ties insurance coverage to improved health outcomes. In recent years, patients with cancer have had greater access to health insurance with protections against lifetime spending caps, annual limits, and higher premiums due to pre-existing conditions. 8% Increase in early stage colorectal cancer diagnoses between 2011 and 2013, after screening was offered without copay through Medicare. 12 THE PHYSICIAN PERSPECTIVE An influx of patients with cancer America s population is growing, changing demographically, and living longer all factors contributing to record numbers of new cancer patients and survivors. Cancer diagnoses in 2016 up nearly 2% from million Americans, all needing continued care, will be living with a history of cancer by An evolving workforce Cancer is the leading cause of death in states. Cancer accounts for of all deaths 1/4 in the U.S. 16 The U.S. oncology workforce is responding to the needs of a rapidly growing patient population, innovative treatment options, and a dramatically changing practice landscape. 12,100 physicians delivered hematology and medical oncology care in 2016 to cancer patients. 24% of oncology practices have at least one genetic counselor on staff, showing growing use of genetic testing for personalized cancer care. 36% of oncology practices that employ advanced practice providers (nurse practitioners and physician assistants) reported hiring more in the past year. Disparities in care Independent of insurance status, significant health disparities persist by race, ethnicity, socioeconomic status, and geography: Compared to white men, African American men with prostate cancer experienced: Longer wait times between diagnosis and treatment 13 More side effects 14 Higher costs of care 14 Appalachian residents have elevated risks of of developing and dying from cancer oncologist per vs. 5 oncologists per 100,000 rural residents. 100,000 urban residents. Practices under strain Oncology practices report increasing administrative burden and cost-saving measures are draining resources and squeezing time spent with patients. More than half of oncology practices surveyed identified increasing administrative and overhead costs as a top pressure. Other top presures facing oncology practices Drug pricing Implementing electronic health records Practices from common medical specialties spent a total of $15.4 billion 41% 39% and an average of 785 hours per physician annually to meet quality reporting requirements. 19 Medical practices complete an average of 37 prior authorization requirements per physician weekly, taking an average of 16 hours of clinician time

4 The Path Forward Ensure Access to Affordable, High-Quality Cancer Care All people with cancer should have health insurance that ensures access to high-quality cancer care delivered by a cancer specialist and provides the full range of services patients need in a timely manner. ASCO is optimistic about the future of the cancer care delivery system, but recognizes the challenges of delivering the highest quality care for all patients with cancer. Building on efforts currently underway, the following ASCO recommendations set forth a framework to strengthen the current system and ensure patients access to cancer care well into the future. 30% of Medicare payments tied to alternative payment models (APMs) in Develop Patient-Centered Payment Models As the nation moves from a volume-based to value-based healthcare reimbursement system, public and private payers should work with oncology providers and patients to develop new payment models that support patient-centered cancer care across healthcare teams and care delivery settings. Furthermore, the Centers for Medicare & Medicaid Services should support testing of multiple payment models in oncology, including ASCO s Patient-Centered Oncology Payment model. Support Development of Cancer Treatments To ensure the ongoing development and delivery of promising new treatments for patients with cancer, the federal government should provide adequate funding and infrastructure support for cancer research, continue funding the Cancer Moonshot Initiative, and provide adequate resources to the Food and Drug Administration to review and approve the safety and efficacy of cancer therapies and diagnostics efficiently and quickly. Promote EHR Interoperability To reach the full potential of cancer-specific rapid learning health systems and accelerate the pace of cancer research, it is essential to speed implementation of the 21st Century Cures Act provisions to promote interoperability of electronic health records (EHRs) and prevent information blocking. 42% of surveyed oncology practices cannot integrate patient information from other EHR systems into their own. Reduce Administrative Burden As regulatory changes have significantly increased the administrative burdens providers face, policymakers and payers should streamline and standardize documentation and reporting requirements so that oncology professionals are able to focus adequate time and resources on their patients. Top 3 strains on oncology practices Increasing expenses Drug pricing Implementing EHRs A Transformed Cancer Care System on the Horizon All stakeholders have a role to play capitalizing on these opportunities and addressing challenges will take greater commitment and collaboration than ever before. ASCO remains dedicated to supporting the efforts of policymakers to strengthen the nation s cancer care delivery system on behalf of all patients with cancer and their providers. For more information, please contact policy@asco.org. 5 6

5 2318 Mill Road, Suite 800 Alexandria, VA Founded in 1964, the American Society of Clinical Oncology, Inc. (ASCO ) is committed to making a world of difference in cancer care. As the world s leading organization of its kind, ASCO represents more than 40,000 oncology professionals who care for people living with cancer. Through research, education, and promotion of the highest-quality patient care, ASCO works to conquer cancer and create a world where cancer is prevented or cured, and every survivor is healthy. ASCO is supported by its affiliate organization, the Conquer Cancer Foundation. Learn more at explore patient education resources at and follow us on Facebook, Twitter, LinkedIn, and YouTube. Visit ascoaction.asco.org for the latest cancer policy developments. Visit ascopubs.org/doi/ /jop for full-text of the 2017 State of Cancer Care in America Report. Visit asco.org/state-of-cancer-care for a digital version of the At A Glance. REFERENCES 1 American Cancer Society: Cancer treatment & survivorship facts & figures Siegel RL, Miller KD, Jemal A: Cancer statistics, CA Cancer J Clin 67:7-30, US Food and Drug Administration: Hematology/oncology (cancer) approvals & safety notifications. approveddrugs/ucm htm 4 US Food and Drug Administration: cobas EGFR Mutation Test v US Food and Drug Administration: Rucaparib. InformationOnDrugs/ApprovedDrugs/ucm htm 6 Hodi FS, Kluger H, Sznol M, et al: Abstract CT001: Durable, long-term survival in previously treated patients with advanced melanoma (MEL) who received nivolumab (NIVO) monotherapy in a phase I trial. Cancer Research 76:CT001-CT001, Howlader N, Noone AM, Krapcho M, et al: SEER Cancer Statistics Review (CSR) seer.cancer.gov/csr/1975_ Japsen B: More doctors to retire as MACRA and value-based pay hit. 9 Banegas MP, Guy GP Jr, de Moor JS, et al: For working-age cancer survivors, medical debt and bankruptcy create financial hardships. Health Aff (Millwood) 35:54-61, Lathan CS, Cronin A, Tucker-Seeley R, et al: Association of financial strain with symptom burden and quality of life for patients with lung or colorectal cancer. J Clin Oncol 34: , Cohen RAM, Martinez ME, Zammitti EP: Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January March Lissenden B, Yao NA: Affordable Care Act changes to Medicare led to increased diagnoses of early-stage colorectal cancer among seniors. Health Aff (Millwood) 36: , Kinlock BL, Thorpe RJ Jr, Howard DL, et al: Racial disparity in time between first diagnosis and initial treatment of prostate cancer. Cancer Contr 23:47-51, Schmid M, Meyer CP, Reznor G, et al: Racial differences in the surgical care of Medicare beneficiaries with localized prostate cancer. JAMA Oncol 2:85-93, Wilson RJ, Ryerson AB, Singh SD, et al: Cancer incidence in Appalachia, Cancer Epidemiol Biomarkers Prev 25: , American Cancer Society: Cancer facts & figures Bluethmann SM, Mariotto AB, Rowland JH: Anticipating the silver tsunami : Prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomarkers Prev 25: , National Center for Health Statistics: Changes in the leading cause of death: Recent patterns in heart disease and cancer mortality, Casalino LP, Gans D, Weber R, et al: US physician practices spend more than $15.4 billion annually to report quality measures. Health Aff (Millwood) 35: , American Medical Association: Health Care Coalition Calls for Prior Authorization Reform US Department of Health & Human Services: HHS reaches goal of tying 30 percent of Medicare payments to quality ahead of schedule. percent-medicare-payments-quality-ahead-schedule.html 8